Multisector Approach to Improve Healthy Eating and Physical Activity Policies and Practices in Early Care and Education Programs: The National Early Care and Education Learning Collaboratives Project, 2013-2017.

PURPOSE AND OBJECTIVES: Embedding healthy eating and physical activity best practices in early care and education settings is important for instilling healthy behaviors early in life. A collaborative partnership between Nemours Children's Health System and the Centers for Disease Control and Prevention was created to implement the National Early Care and Education Learning Collaboratives Project (ECELC) in childcare settings in 10 states. We measured improvement at the program level by the self-reported number of best practices implemented related to healthy eating and physical activity. INTERVENTION APPROACH: The ECELC implemented a collaborative model with state-level partners (eg, child care resource and referral networks) and early care and education programs. Intervention components received by program directors and lead teachers included 1) self-assessment, 2) in-person learning and training sessions, 3) action planning and implementation, 4) technical assistance, and 5) post-reassessment. EVALUATION METHODS: A pre-post design assessed self-reported policies and practices related to breastfeeding and infant feeding, child nutrition, infant and child physical activity, screen time, and outdoor play and learning as measured by the validated Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) best practices instrument. The sample included 1,173 early care and education programs. RESULTS: The number of best practices met for each of the 5 NAP SACC areas increased from pre-assessment to post-assessment approximately 6 months later and ranged from 1.5 to 4.7 best practices (P < .001). Almost all increases occurred regardless of participation in the Child and Adult Care Food Program, Quality Rating Improvement System, Head Start/Early Head Start, and/or accreditation status. IMPLICATIONS FOR PUBLIC HEALTH: The innovative and collaborative partnerships led to broad implementation of healthy eating and physical activity-based practices in early care and education settings. Development, implementation, and evaluation of policy and practice-based partnerships to promote healthy eating and physical activity among children attending early care and education programs may contribute to obesity prevention in the United States.

Correlates of fruit and vegetable intake among parents and adolescents: findings from the Family Life, Activity, Sun, Health, and Eating (FLASHE) study.

OBJECTIVE: The present study aimed to examine the correlates of fruit and vegetable intake (FVI) separately among parents and their adolescents. DESIGN: Cross-sectional surveys. SETTING: Online survey. SUBJECTS: Parents and adolescents completed the Family Life, Activity, Sun, Health, and Eating (FLASHE) survey through the National Cancer Institute. The survey assessed daily intake frequencies of food/beverage groups, psychosocial, parenting and sociodemographic factors. Generalized linear models were run for both parents and adolescents, for a total of six models (three each): (i) sociodemographic characteristics; (ii) psychosocial factors; (iii) parent/caregiver factors. RESULTS: Parent participants (n 1542) were predominantly 35-59 years old (86 %), female (73 %), non-Hispanic White (71 %) or non-Hispanic Black (17 %), with household income <$US 100 000 (79 %). Adolescents (n 805) were aged 12-14 years (50 %), non-Hispanic White (66 %) and non-Hispanic Black (15 %). Parents consumed 2·9 cups fruits and vegetables (F&V) daily, while adolescents consumed 2·2 cups daily. Educational attainment (higher education had greater FVI) and sex (men consumed more than women; all P<0·001) were significant FVI predictors. Parents with greater autonomous and controlled motivation, self-efficacy and preferences for fruit reported higher FVI (all P<0·001). Similarly, adolescents with greater autonomous and controlled motivation, self-efficacy and knowledge reported higher FVI (all P<0·001). Parenting factors of importance were co-deciding how many F&V teens should have, rules, having F&V in the home and cooking meals from scratch (all P<0·05). CONCLUSIONS: Findings suggest factors that impact FVI among parents and their adolescent(s), which highlight the importance of the role of parent behaviour and can inform tailored approaches for increasing FVI in various settings.

Technical Assistance and Changes in Nutrition and Physical Activity Practices in the National Early Care and Education Learning Collaboratives Project, 2015-2016.

PURPOSE AND OBJECTIVES: The National Early Care and Education Learning Collaboratives Project (ECELC) aims to improve best practices in early care and education (ECE) programs in topic areas of the Nutrition and Physical Activity Self-Assessment in Child Care (NAP SACC). Technical assistance is a component of the ECELC, yet its effect on outcomes is unclear. Beyond dose and duration of technical assistance, limited research exists on characteristics of technical assistance that contribute to outcomes. The objective of this study was to identify and describe technical assistance characteristics and explore associations with NAP SACC outcomes. INTERVENTION APPROACH: We collected data from 10 collaboratives comprising 84 ECE programs in 2 states in 2015-2016. The objective of technical assistance was to support programs in improving best practices. Technical assistance was provided to programs via on-site, telephone, or email and was tailored to program needs. EVALUATION METHODS: We used a mixed-methods design to examine associations between technical assistance and NAP SACC outcomes. We used multiple regression analysis to assess quantitative data and qualitative comparative analysis to determine necessary and sufficient technical assistance conditions supporting NAP SACC outcomes. We also conducted a document review to describe technical assistance that referred conditions identified by the qualitative comparative analysis. RESULTS: Regression analyses detected an inverse relationship between changes in NAP SACC scores and hours of technical assistance. No clear pattern emerged in the qualitative comparative analysis, leaving no necessary and sufficient conditions. However, the qualitative comparative analysis identified feedback as a potentially important component of technical assistance, whereas resource sharing and frequent email were characteristics that seemed to reduce the likelihood of improved outcomes. Email and resource sharing were considered primarily general information rather than tailored technical assistance. IMPLICATIONS FOR PUBLIC HEALTH: Technical assistance may be used in programs and made adaptable to program needs. The inclusion and evaluation of technical assistance, especially tailored approaches, is warranted for environmental interventions, including ECE settings.

Assessment of nutrition and physical activity practices using self-report and observation in early care and education across multiple US states.

OBJECTIVE: The National Early Care and Education Learning Collaboratives (ECELC) Project aims to promote healthy physical activity and nutrition environments, policies and practices in early care and education (ECE) programmes across multiple states. The present pilot study sought to assess changes to the physical activity and nutrition practices in a sub-sample of ECE programmes participating in the ECELC using the Environment and Policy Assessment and Observation (EPAO). Additionally, it sought to compare results with the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC). DESIGN: Quasi-experimental pre-post pilot study where paired-sample t tests examined changes to physical activity and nutrition practices from pre-assessment to post-assessment (P<0·05). Pearson correlation coefficients examined change scores from EPAO compared with NAP SACC with statistical significance set at a two-sided α level of P<0·10 to account for sample size. SETTING: The study occurred among ECE programmes. SUBJECTS: Pre-school classrooms in nineteen ECE programmes across four US states were observed. RESULTS: EPAO data demonstrated an increase in total score from pre-assessment to post-assessment (150 (sd 30) to 176 (sd 35)). NAP SACC change scores demonstrated little relationship with EPAO domain change scores, with exceptions in Nutrition Policy and Physical Activity Policy (r=-0·4 and -0·6, respectively). CONCLUSIONS: The overall improvements reported through the EPAO suggest participation in the ECELC resulted in changes in critical nutrition- and physical activity-related practices. However, considerable differences in data reported using the NAP SACC compared with the EPAO suggest subjective data should be interpreted with caution and objective measurement should be used when feasible.

Improving Nutrition and Physical Activity Policies and Practices in Early Care and Education in Three States, 2014-2016.

The National Early Care and Education Learning Collaboratives (ECELC) project aims to facilitate best practices in nutrition, physical activity, screen time, and breastfeeding support and infant feeding among early care and education (ECE) programs across multiple states. The project uses a train-the-trainer approach with 5, in-person learning-collaborative sessions, technical assistance, and action planning. We describe the longitudinal practice-based evaluation of the project and assess whether ECE programs evaluated (n = 104) sustained changes in policies and practices 1 year after completing the project. The number of best practices increased from pre-assessment to post-assessment (P < .01) but did not change significantly from post-assessment to follow-up assessment. ECELC shows promise as an approach to incorporate professional development and training focused on improving best practices for environment-level child nutrition and physical activity, which is one strategy among many that are warranted for obesity prevention in young children.

Efficacy of a Revised Prototype Solution to Facilitate the Removal of Dental Calculus: A follow-up proof-of-concept study.

Purpose The purpose of this follow-up proof-of-concept study was to determine the efficacy of a revised calculus disruption solution in facilitating the removal of both supragingival and subgingival calculus in-vivo, as measured by time, difficulty, and pressure required to remove supragingival and subgingival calculus.Methods Patients from a dental school in Minnesota were recruited to participate in a randomized, split-mouth, cross sectional proof-of-concept study comparing time, difficulty and pressure used with hand instrumentation alone compared to the use of a calculus disruption solution and hand instrumentation. Quadrants were randomized to either treatment or control group. Descriptive and inferential statistics were used to analyze the amount of time used. A paired Student's t-test was used to analyze the primary outcome (α = 0.05). Post-treatment questionnaires were completed by the investigator and participants to score the perceived difficulty and pressure required to remove calculus.Results Thirty participants completed the study. An average of 3.1 minutes less time was needed to remove supra and subgingival calculus in the treatment quadrants although this was not statistically significant (p=0.5757). The secondary outcomes, the investigator and participants' perceived difficulty and pressure used for calculus removal showed either no difference, or slight improvements in the treatment quadrants. Overall, the product was well tolerated by participants.Conclusion Quadrants treated with a calculus disruption solution, required slightly less time than control quadrants for calculus removal with hand instruments although the difference was not statistically significant. Reformulation to increase the viscosity of the solution may improve efficacy. Future studies should include a larger sample size, using multiple operators, and a double-blind study design.

Comparing test methods for moisture-vapor transmission rate (MVTR) for vascular access transparent semipermeable dressings.

BACKGROUND: Catheter insertion sites are commonly covered by transparent film dressings, offering protection of the insertion site from external contaminants and securement of the catheter while allowing site observation through a clear window. Currently, there is considerable focus on creating IV film dressings with ever-increasing moisture vapor transmission rates (MVTR) to prevent the accumulation of moisture under the film and reduce the risk of infection. These increasingly high MVTR IV dressings are often promoted as superior to IV dressings with lesser MVTR values. METHODS: Since there are different methods to determine MVTR, we chose to test a series of commercially available dressings with two standard methods to compare the results and better understand the information provided by this measurement. We used European Standard EN 13726 to test the MVTR of seven different IV dressings with two different methods (upright and inverted). RESULTS: We measured a range of MVTR values from 773 to 2838 g/m2/day for the upright method and from 845 to 30,530 g/m2/day for the inverted method for the seven IV dressings tested. Three dressings showed statistically different MVTR values with the two test methods. CONCLUSIONS: The MVTR test method (upright or inverted) used and considered for IV dressing product selection matters because the results obtained can be very different. We suggest that the upright method is better suited for IV dressings because they are not in constant contact with fluid. We conclude that the inverted method alone is not adequate to compare IV dressings.

Development and Initial Validation of the Risk Analysis Index for Measuring Frailty in Surgical Populations.

Importance: Growing consensus suggests that frailty-associated risks should inform shared surgical decision making. However, it is not clear how best to screen for frailty in preoperative surgical populations. Objective: To develop and validate the Risk Analysis Index (RAI), a 14-item instrument used to measure surgical frailty. It can be calculated prospectively (RAI-C), using a clinical questionnaire, or retrospectively (RAI-A), using variables from the surgical quality improvement databases (Veterans Affairs or American College of Surgeons National Surgical Quality Improvement Projects). Design, Setting, and Participants: Single-site, prospective cohort from July 2011 to September 2015 at the Veterans Affairs Nebraska-Western Iowa Heath Care System, a Level 1b Veterans Affairs Medical Center. The study included all patients presenting to the medical center for elective surgery. Exposures: We assessed the RAI-C for all patients scheduled for surgery, linking these scores to administrative and quality improvement data to calculate the RAI-A and the modified Frailty Index. Main Outcomes and Measures: Receiver operator characteristics and C statistics for each measure predicting postoperative mortality and morbidity. Results: Of the participants, the mean (SD) age was 60.7 (13.9) years and 249 participants (3.6%) were women. We assessed the RAI-C 10 698 times, from which we linked 6856 unique patients to mortality data. The C statistic predicting 180-day mortality for the RAI-C was 0.772. Of these 6856 unique patients, we linked 2785 to local Veterans Affairs Surgeons National Surgical Quality Improvement Projects data and calculated the C statistic for both the RAI-A (0.823) and RAI-C (0.824), along with the correlation between the 2 scores (r = 0.478; P < .001). Of these 2785 patients, there were sufficient data to calculate the modified Frailty Index for 1021, in which the C statistics were 0.865 (RAI-A), 0.797 (RAI-C), and 0.811 (modified Frailty Index). The correlation between the RAI-A and RAI-C was 0.547, and the correlations of the modified Frailty Index to the RAI-A and RAI-C were 0.301 and 0.269, respectively (all P < .001). A cutoff of RAI-C of at least 21 classified 18.3% patients as "frail" with a sensitivity of 0.50 and specificity of 0.82, whereas the RAI-A was less sensitive (0.25) and more specific (0.97), classifying only 3.7% as "frail." Conclusions and Relevance: The RAI-C and RAI-A represent effective tools for measuring frailty in surgical populations with predictive ability on par with other frailty tools. Moderate correlation between the measures suggests convergent validity. The RAI-C offers the advantage of prospective, preoperative assessment that is proved feasible for large-scale screening in clinical practice. However, further efforts should be directed at determining the optimal components of preoperative frailty assessment.